Stroke, Possible HACE, Ascending Too Fast, Alaska, Mount McKinley

STROKE, POSSIBLE HACE, ASCENDING TOO FAST

Alaska, Mount McKinley

On June 3, 1988, two members of the “New York Alpine Club” Korean Cassin Ridge expedition were hoisted from a camp at 5500 meters into a Chinook Helicopter by the U. S. Army’s 228th Aviation Company from Ft. Wainwright, AK. This event occurred only seven days after a hoist from the same location which was the highest hoist operation ever done by the U. S. Military. Lee (29) and Chung (27) were flown to Talkeetna. Chung was examined during the flight by Dr. Peter Hackett. Chung was then flown to Anchorage and admitted to Humana Hospital where he was diagnosed as having suffered a stroke. (Source: Cliff Beaver, Mountaineering Ranger, Denali National Park)

Analysis

Once again, interagency cooperation between the National Park Service and the U. S. Army, along with the Mount McKinely guides and the Canadian climbers and the Denali Medical Research Project accomplished a major rescue and a repeat of the highest helicopter hoist operation ever done by the U. S. Military.

Chung, 27 years of age, apparently suffered a stroke one day after he and Lee assisted in the rescue of Baek. The stroke could be attributed to dehydration and altitude, perhaps cerebral edema. His life was saved by these rescue efforts.

This was the third major rescue of Korean climbers from the upper reaches of the Cassin Ridge during the past three years. In each of these cases, the parties have not taken time to acclimatize on a lesser route prior to starting their rapid ascent of the Cassin. We also are seeing parties attempting the Cassin without sufficient anchors and ropes to conduct a descent of the route should problems arise and a retreat become necessary. We must emphasize that rescue from the more difficult routes is extremely difficult and dangerous for everyone involved. Response times for ground teams can take many days just to arrive at the accident site. Climbing teams must be prepared to handle their own problems, including a descent or lowering of an injured/ill person down the route. The request for a rescue must be made only as a last resort, after all other options for self-help have been exhausted. (Source: Bob Seibert, Mountaineering Ranger, Denali National Park)

Analysis

Medically, this case was unusual and difficult to diagnose, which contributed to the confusion about whether or not a rescue was truly warranted. A clear description of the exact condition of the victim, stating that his legs were spastic, for example, and that he could not stand up because of his legs, would have been useful. The fact that he awoke suddenly unable to use his legs indicates an acute event in the brain or spinal cord. Although an MRI scan of the brain revealed cerebral edema, this was an unusual presentation for HACE. This climber apparently had a small “stroke” as well. In the field, the exact diagnosis was irrelevant; the victim needed evacuation off the mountain and was unable to help much in his rescue. Interestingly, his legs improved over the five days while waiting for rescue (which is consistent with a stroke), and he was eventually able to move down with assistance. Dexamethasone may have been of some value, but was unavailable. During the hoist into the helicopter, he suffered a flash superficial freezing of both hands since his ungloved hands were exposed to rotor wash of over 100 kph and temperature was -24 degrees C.

On examination in Talkeetna, the patient could walk with difficulty, both legs were spastic, and reflexes were hyperactive. Bilateral ankle clonus was also present. By the time he left the hospital a few days later, he was making good progress with walking rehabilitation training, his frostbite was healing, and he was able to go back to his job as a letter carrier in New Jersey a month later. (Source: Dr. Peter Hackett, Director, Denali Medical Research Project)